Healthcare Provider Details

I. General information

NPI: 1013171552
Provider Name (Legal Business Name): EVA MARIA THEODOSIADIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 02/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 ELM ST SUITE 507
MC LEAN VA
22101-6007
US

IV. Provider business mailing address

6845 ELM ST SUITE 507
MC LEAN VA
22101-6007
US

V. Phone/Fax

Practice location:
  • Phone: 571-282-8254
  • Fax: 571-267-3083
Mailing address:
  • Phone: 571-282-8254
  • Fax: 571-267-3083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number259846
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number259846
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberMD040694
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101251747
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101251747
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD040694
License Number StateDC
# 7
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD040694
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: